a 20 year old female client with schizophrenia is scheduled to receive risperidone risperdal 2mg at bedtime when the nurse attempts to administer the a 20 year old female client with schizophrenia is scheduled to receive risperidone risperdal 2mg at bedtime when the nurse attempts to administer the
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Nursing Elites

HESI LPN

HESI Mental Health Practice Questions

1. A 20-year-old female client with schizophrenia is scheduled to receive risperidone (Risperdal) 2mg at bedtime. When the nurse attempts to administer the medication, the client states, 'I am not going to take that medicine, and you can't make me.' What action should the nurse take?

Correct answer: D

Rationale: In this scenario, the correct action for the nurse to take is to respect the client's autonomy and decision-making capacity. It's crucial to document the medication refusal accurately in the client's record. Administering the medication via a nasogastric tube or substituting it with an injectable form would violate the client's right to refuse treatment and should only be considered in extreme cases after consulting with the healthcare team. Encouraging the client to take the medication because it will help her sleep disregards her autonomy and choice in the matter.

2. Which of the following is an appropriate intervention for a patient experiencing a hypertensive crisis?

Correct answer: B

Rationale: Administering a beta-blocker intravenously is the correct intervention for a patient experiencing a hypertensive crisis. Beta-blockers help quickly reduce blood pressure and prevent complications such as stroke or heart attack. Placing the patient in a supine position can worsen the condition by reducing venous return and increasing the workload of the heart. Encouraging the patient to drink fluids is not recommended as it can exacerbate hypertension by increasing fluid volume. Applying a cold compress to the forehead does not address the underlying cause of the hypertensive crisis and is unlikely to provide significant benefit.

3. As the immediate supervisor of the Rural Health Midwives, the PHN prepares a supervisory plan. Which of the following would be the PHN's activity?

Correct answer: B

Rationale: The correct answer is B: listing supervisory activities. When preparing a supervisory plan, the Public Health Nurse (PHN) needs to list the specific supervisory activities that need to be carried out. This helps in organizing and outlining the tasks that need to be accomplished to ensure effective supervision. Choices A, C, and D are incorrect because although needs assessment, identifying training needs, and formulating objectives are important aspects of supervisory planning, they are not specifically related to the act of preparing a detailed list of supervisory activities.

4. A hospitalized client needs a chest x-ray. The radiology department calls the nursing unit and says that they are sending a transporter for the client. When entering the client’s room, the priority action is to:

Correct answer: A

Rationale: The correct action to take when a transporter arrives to take a hospitalized client for a procedure is to check the client's identification bracelet. This step is crucial to prevent errors and ensure that the correct patient is receiving the intended procedure. Informing the client about the procedure and preparing them for transport are important steps in the process, but verifying the client's identity takes precedence to ensure patient safety. Verifying the x-ray order, though important, is not the priority action when the transporter arrives; confirming the patient's identity is essential before proceeding with any procedures.

5. What is a key aspect of care for a child with an indwelling urinary catheter?

Correct answer: B

Rationale: Monitoring for signs of infection is crucial when caring for a child with an indwelling urinary catheter. This is because catheter-associated urinary tract infections are common in such cases. Increasing fluid intake can be beneficial, but monitoring for infection takes precedence as it is crucial to prevent complications. Restricting mobility is not a key aspect of care for a child with an indwelling urinary catheter unless specifically advised by a healthcare provider. Administering daily antibiotics without proper assessment and indication can lead to antibiotic resistance and is not a standard practice in caring for a child with an indwelling urinary catheter.

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